Slide 1138th APHA Annual Meeting
Senior Research Scientist, Texas Health Institute
Associate Professor, University of Texas School of Public Health
Nadia J. Siddiqui, MPH
Jonathan P. Purtle, MPH, MSc
Program Manager, Drexel University School of Public Health
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Background and Purpose
With support from the Joint Center for Political and Economic Studies, we conducted a comprehensive review of the Patient Protection and Affordable Care Act of 2010:
To identify and describe provisions specific to race, ethnicity and language; and general provisions likely to have a significant affect on diverse populations.
To assess status, challenges and opportunities of health care reform provisions for improving the health and health care of racially and ethnically diverse populations.
To offer a template and user-friendly framework for documenting and tracking implementation timeline, appropriations and federal agency oversight responsibility.
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Framework for Review
Review of provisions addressing
12 key public health, health care system and health disparities priorities.
Race, Ethnicity and Language-Specific Priorities
A. Data Collection and Reporting by Race, Ethnicity & Language
B. Workforce Diversity
D. Health Disparities Research
F. Addressing Health Disparities in Health Insurance Reforms
General Priorities
C. Quality Improvement
D. Cost Containment
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General Provisions
2001
2005
1421
1322
1311
10503
5503
5207
3504
General Provisions (continued)
3011
3012
3013
3001
2501
6401
General Provisions (continued)
Public Health & Prevention
4001
4401
10413
4003
Examples of Public Health Opportunities for Advancing Health Equity through General Provisions
4001. National Prevention and Public Health Council will provide coordination and leadership at the federal level for public health and other services to consider evidence-based models, policies and innovative approaches for transformative models of public health and prevention.
4003. The CDC will convene an independent Community Preventive Services Task Force to review scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of community preventive interventions for the purpose of developing recommendations. Recommendations must address specific populations and social, economic and physical environments that can have broad effects on health disparities.
4201. The CDC is authorized to award competitive Community Transformation Grants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities and develop a stronger evidence-base of effective prevention programming.
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Data Collection & Reporting
Example of Potential Public Health Obligation and Opportunity:
4302. No later than 2 years after the date of enactment of this title, any federally conducted or supported public health program, activity or survey must collect and report data on race, ethnicity, and primary language for applicants, recipients or participants. Data must be sufficient to generate statistically reliable estimates by racial, ethnic, or primary language subgroups. In collecting these data, the OMB standards for measurement of race, ethnicity and language must be used at a minimum.
Provisions
4302
4302
4302
Workforce Diversity
Example of Potential Public Health Obligation and Opportunity:
5303. Grants to promote public health dentistry shall give priority to applicants with experience in minority training with emphasis on cultural competence and health literacy; and who have placements in areas that serve health disparities populations.
Provision Description
Section No.
5301, 5302, 5303, 5306, 5309
Health professions training on diversity and/or CLAS
5402, 5403, 4305, 5313, 5507
Investment in HBCU and minority-serving institutions
2104
5001
Cultural Competence (CC)
5307. Cultural Competency, Prevention and Public Health Grants will be established to develop, evaluate and disseminate research, demonstration projects, and model curricula for cultural competency proficiency, prevention, public health proficiency and reducing health disparities.
Provision Description
Section No.
5307
5301, 5507
5203
10334
Table 4. Health Disparities Research
Example of Potential Public Health Obligation and Opportunity:
6301. PCORI will identify national priorities for research, addressing practice variation and health disparities in terms of delivery and outcomes of care and the potential for new evidence to improve patient health and quality of care.
Provision Description
Section No.
6301
5401
Promote National Center for Minority Health and Health Disparities (NCMHHD) to Institute status
10334
5307, 2952, 4305
Table 5. Health Disparities & Prevention
Example of Potential Public Health Obligation and Opportunity:
 4102. CDC will create a public education oral health campaign with a priority to address oral health disparities in a culturally and linguistically competent manner.
Provision Description
Section No.
4102
3507
2951
10221
Provision Description
Section No.
2901
3306
1557
1303
1303
1001
1001
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Advancing the Health of Communities
Leveraging support for community-based strategies and engagement in reducing disparities.
Communities must be active and involved participants in setting overall objectives, specific goals and strategies for achieving them.
2. Promoting integrated strategies across health and social services to improve the health of diverse communities.
Need for direct, concerted research, policy and programs that seek to alter significantly the negative influence of social determinants in diverse communities.
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Health Care Organization-Based Initiatives
1. Developing and testing model programs that link specific organizational efforts to reducing disparities and improving quality of care.
Organizations must be committed to support practitioners through more comprehensive and active engagement in caring for diverse patients.
2. Documenting and linking non-profit community needs assessment/benefit requirements to health care reform incentives to address disparities.
Need to reach beyond demonstrations and funding opportunities.
Require provider organizations to show evidence of working to reduce disparities—e.g. through education & community outreach
3. Preserving and transitioning the health care safety net.
Providing direct support for safety net hospitals, particularly in regions with large uninsured and undocumented populations.
Guidance for philanthropic organizations on ways to support safety net.
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Individual Level Initiatives
Developing effective care/disease management and self management interventions and protocols for diverse patients.
New programs will need to address how and to what extent inattention to race- and culture-specific and language/literacy concerns may create impediments to care management and self management.
Mitigating the effects of overweight/obesity and negative environmental factors that may impede progress on reducing disparities.
Greater health care provider awareness of culture and challenges faced by diverse populations will be important for reducing disparities in care and adherence to treatment.
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Conclusions
Great breadth of opportunities in ACA to reduce disparities and improve health equity.
However, for many provisions, depth in terms of detail, strategy for implementation, methods for implementation, and measurement/evaluation to assess progress, is still lacking.
Allocations and federal agency roles, likewise, are unspecified for many provisions.
As of 8/1/2010, nearly two-thirds of the diversity specific provisions lacked specificity around appropriations and timeline
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What will a new Congress mean for public health efforts to eliminate racial/ethnic disparities and advance health equity through ACA?
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Next Steps
Appropriations, appropriations, appropriations—assuring adequate funding for provisions.
Track timing and process for rollout.
Communicate with agencies likely to oversee identified priority areas about status and progress in adding content to these areas.
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Dennis P. Andrulis, PhD, MPH
Senior Research Scientist, Texas Health Institute
Associate Professor, University of Texas School of Public Health
dpandrulis@gmail.com
nsiddiqui@texashealthinstitute.org
Program Manager, Drexel University School of Public Health
jpp46@drexel.edu
Presenter Disclosures
No relationships to disclose